Guidelines recommend Helicobacter pylori testing and treatment for patients with a history of peptic ulcer disease (PUD). This assumes that PUD has been documented, and that successful H. pylori eradication eliminates the need for further therapy.
In this study, researchers from the United States, evaluated the clinical outcome and costs of an H. pylori test-and-treat (T & T) strategy.
|38% of the T & T group tested positive for H. pylori.|
|Archives of Internal Medicine|
The team assessed 650 patients receiving long-term acid suppression therapy for physician-diagnosed PUD. Patients were randomized to T & T for H. pylori (n = 321) or to usual care (n = 329).
The researchers measured presence and severity of PUD symptoms, use of acid-reducing medication, and acid-peptic-related health care costs during 12-month follow-up.
They found that 17% of study participants had PUD confirmed by radiography or endoscopy.
The researchers also found that only 38% of the T & T group tested positive for H. pylori.
Furthermore, at 12 months, patients in the T & T group were less likely to report ulcer-like dyspepsia, or the use of acid-reducing medication;
However, 75% of the T & T group used acid-reducing medication during the second half of the 12-month follow-up.
The research team determined that, during the 12 months after randomization, the T & T group had higher total acid-peptic-related costs than the usual care group.
Dr James Allison’s team concluded, “Most patients receiving long-term acid suppression therapy for physician-diagnosed PUD in community practice settings are likely to have H. pylori-negative, uninvestigated dyspepsia”.
“Routine testing and treating for H. pylori will not reduce acid-peptic-related costs and have only a modest (though statistically significant) effect in reducing clinical symptoms and use of acid-reducing medications”.